Abstract Background The main features of polycystic ovary syndrome (PCOS) are abnormal follicular development and ovulatory dysfunction, which are caused by excessive apoptosis of ovarian granulosa cells. Acupuncture has been shown to improve follicular development abnormalities in patients with PCOS, but its mechanism is unknown. This study hypothesized that the mechanism of acupuncture on follicular development abnormalities in PCOS patients is the inhibition of granulosa cell apoptosis through LncMEG3-mediated regulation of miR-21-3p. Methods A PCOS-like rat model was established using subcutaneous injection of dehydroepiandrosterone (DHEA). Acupuncture was performed on rats for 15 d (CV-4, RN-3, CV-6, SP-6 and EX-CA 1). Ovarian morphology was observed by HE staining, and sex hormone and AMH levels were detected by ELISA. Primary granulosa cells were isolated from each group of rats to assess the association of acupuncture treatment, LncMEG3, miR-21-3p, and granulosa cell apoptosis in rats with PCOS. Results LncMEG3 and miR-21-3p were highly expressed in the ovarian granulosa cells of rats with PCOS, and LncMEG3-mediated regulation of miR-21-3p was involved in the development of PCOS in rats. Silencing of MEG3 attenuated sex hormone dysregulation and ovarian histopathological changes in PCOS rats and promoted follicle cell development and maturation. In addition, silencing MEG3 increased the viability and number of granulosa cells. In addition, silencing MEG3 further inhibited early and late apoptosis of ovarian granulosa cells in PCOS rats. Acupuncture improved polycystic ovarian morphology and sex hormone levels in PCOS rats. Acupuncture intervention increased the viability and number of granulosa cells. Acupuncture intervention inhibited early and late apoptosis of ovarian granulosa cells in PCOS rats by targeting miR-21-3p via LncMEG3. Conclusion These results suggest that acupuncture can downregulate LncMEG3, thereby targeting and regulating miR-21-3p to suppress early and late granulosa cell apoptosis and normalize their proliferation. These factors ultimately compensate for abnormal follicular development. These findings shed light on the clinical potential of acupuncture as a safe treatment for follicular developmental abnormalities in PCOS. Highlights LncMEG3-mediated inhibition of miR-21-3p regulates ovarian granulosa cell apoptosis. LncMEG3 and miR-21-3p are involved in the occurrence and development of PCOS-related abnormal follicular development. CuONPs induce co-occurrence of autophagy activation and autophagic flux blockade. Acupuncture can improve the sex hormone levels and follicular development in the context of PCOS. The underlying mechanism of acupuncture in the treatment of PCOS abnormal follicular development was revealed.

Abstract Compound Danshen Dripping Pills (CDDPs) have been used in clinical treatment to protect the heart from ischemia/reperfusion (IR) injury for many years. However, the underlying mechanism implicated in the protective effects remains to be explored. Here, we determined the effects of CDDPs in Sprague-Dawley rats with the IR model. Cardiac function in vivo was assessed by echocardiography. Transmission electron microscopy, histological and immunohistochemical techniques, Western blotting and recombinant adeno-associated virus 9 transfection were used to illustrate the effects of CDDPs on IR and autophagy. Our results showed that pretreatment with CDDPs decreased the level of serum myocardial enzymes and infarct size in rats after IR. Apoptosis evaluation showed that CDDPs significantly ameliorated the cardiac apoptosis level after IR. Meanwhile, CDDPs pretreatment increased myocardial autophagic flux, with upregulation of LC3B, downregulation of p62, and increased autophagosomes and autolysosomes. Moreover, the autophagic flux inhibitor chloroquine could increase IR injury, while CDDPs could partially reverse the effects. Furthermore, our results showed that the activation of AMPK/mTOR was involved in the cardioprotective effect exerted by CDDPs. Herein, we suggest that CDDPs partially protect the heart from IR injury by enhancing autophagic flux through the activation of AMPK/mTOR.

OBJECTIVE: To investigate changes in the expenditure of giving birth in health-care facilities in rural China during 1998-2007, to examine the financial burden on households, particularly poor ones, and to identify factors associated with out-of-pocket expenditure. METHODS: Cross-sectional data on births between 1998 and 2007 were obtained from national household surveys conducted in 2003 and 2008. Descriptive statistics and log-linear models were used to identify factors associated with out-of-pocket expenditure on delivery. FINDINGS: During 1998-2007, the proportion of facility-based deliveries increased from 55% to 90%. In 2007, 60% of births occurred at county-level or higher-level facilities. The Caesarean delivery rate increased from 6% to 26%. Total expenditure on a facility-based delivery increased by 152%, with a marked rise from 2002 onwards with the introduction of the New Cooperative Medical Scheme. In 2007, out-of-pocket expenditure on a facility-based delivery equalled 13% of the mean annual household income for low-income households. This proportion had decreased from 18% in 2002 and differences between income groups had narrowed. Regression models showed that Caesarean delivery and delivery at a higher-level facility were associated with higher expenditure in 2007. The New Cooperative Medical Scheme was associated with lower out-of-pocket expenditure on Caesarean delivery but not on vaginal delivery. CONCLUSION: Expenditure on facility-based delivery greatly increased in rural China over 1998-2007 because of greater use of higher-level facilities, more Caesarean deliveries and the introduction of the New Cooperative Medical Scheme. The financial burden on the rural poor remained high.

OBJETIVO: Investigar los cambios que ha experimentado el gasto correspondiente al alumbramiento en los centros sanitarios de las zonas rurales de China entre 1998 y 2007, con el fin de examinar la carga económica que supone para las familias, especialmente para las más desfavorecidas, y para identificar los factores asociados a los desembolsos efectuados. MÉTODOS: Se obtuvieron los datos de una muestra aleatoria y representativa de los nacimientos que tuvieron lugar entre 1998 y 2007 a través de las encuestas llevadas a cabo en hogares entre 2003 y 2008. Se emplearon estadísticas descriptivas y modelos logarítmicos lineales para identificar los factores asociados con los desembolsos efectuados para la asistencia al parto. RESULTADOS: Durante el periodo comprendido entre 1998 y 2007, la proporción de partos en centros sanitarios aumentó de un 55% a un 90%. En 2007, el 60% de los nacimientos tuvieron lugar en centros sanitarios del condado o de un ámbito territorial más elevado. El porcentaje de partos por cesárea aumentó de un 6% a un 26%. El gasto total en partos asistidos en un centro sanitario aumentó en un 152%, registrando un marcado aumento desde 2002 en adelante con la introducción del Nuevo Sistema de Asistencia Médica Cooperativa. En 2007, los desembolsos efectuados para un parto asistido en un centro sanitario equivalieron al 13% de los ingresos anuales medios de un hogar de bajos ingresos. Esta proporción supuso un descenso desde el 18% registrado en 2002 y las diferencias entre grupos de ingresos se redujeron. Los modelos de regresión mostraron que los partos por cesárea y los partos en los centros sanitarios de un nivel superior estuvieron asociados a un mayor gasto en 2007. El Nuevo Sistema de Asistencia Médica Cooperativa se asoció a un menor desembolso efectuado en los partos por cesárea, pero no en los partos vaginales. CONCLUSIÓN: El gasto en partos asistidos en centros sanitarios ha aumentado significativamente en China entre 1998 y 2007 debido a un mayor uso de las instalaciones de un nivel más elevado, a un mayor número de partos por cesárea y a la introducción del Nuevo Sistema de Asistencia Médica Cooperativa. La carga económica para las familias más desfavorecidas del entorno rural siguió siendo elevada.

OBJECTIF: Étudier l'évolution des dépenses liées à la naissance dans les établissement de soins de santé en Chine rurale durant les années 1998-2007, analyser la charge financière afférente sur les ménages, en particulier les plus pauvres, et identifier les facteurs associés aux paiements directs. MÉTHODES: Des données croisées sur les naissances entre 1998 et 2007 ont été obtenues à partir d'enquêtes nationales sur les ménages réalisées en 2003 et en 2008. Des statistiques descriptives et des modèles par régression (log-linéaires) ont été utilisés pour identifier les facteurs associés aux paiements directs relatifs aux naissances. RÉSULTATS: Pendant les années 1998-2007, la proportion d'accouchements en maternité s'est accrue de 55 à 90%. En 2007, 60% des naissances ont eu lieu dans des centres de comté ou dans des établissements plus importants. Le taux d'accouchements par césarienne est passé de 6 à 26%. Les dépenses totales pour accouchement en établissement médical ont augmenté de 152%, avec une augmentation marquée depuis 2002, suite à l'introduction du nouveau système d'assurance-maladie facultatif (New Cooperative Medical Scheme). En 2007, les paiements directs pour un accouchement dans un établissement médical comptaient pour 13% des revenus annuels moyens des ménages à faible revenu. Cette proportion a diminué de 18% en 2002 et les différences entre les tranches de revenu se sont estompées. Les modèles par régression montrent que l'accouchement par césarienne et l'accouchement dans un établissement de plus haut niveau s'accompagnaient de dépenses plus élevées en 2007. Le nouveau système d'assurance-maladie facultatif était, quant à lui, associé à des paiements directs moindres pour l'accouchement par césarienne, mais non pour l'accouchement par voie basse. CONCLUSION: Les dépenses afférentes à l'accouchement en établissement de soins de santé ont beaucoup augmenté dans la Chine rurale entre 1998 et 2007 du fait du recours plus fréquent à des établissements de plus haut niveau, du nombre accru d'accouchements par césarienne et de l'introduction du nouveau système médical d'assurance-maladie. La charge financière sur les familles rurales pauvres est restée élevé.